Kornimate/medical-research-clean huggingface dataset:
validation of the reps prediction tool

Conditions: Residual Neuromuscular Blockade; Curarization, Postoperative Residual; Postoperative Respiratory Complication

Summary: neuromuscular blocking agents' (nmba) use during surgery is associated with postoperative respiratory complications and increased risk of readmission to the hospital following ambulatory surgery. residual neuromuscular block (rnmb) after surgery is difficult to identify. we have recently developed the residual neuromuscular block prediction score (reps), that predicts the risk for postoperative rnmb. our primary objective is now to assess the predictive ability of the reps for respiratory complications within seven days following general anaesthesia. the secondary objective is to compare the predictive values of reps and train-of-four (tof)-ratio below 0.90 for respiratory complications.

residual neuromuscular blockade occurs in about 20-60% of patients and depends on compound and dose of nmba reversal agent used. while on the one hand, nmbas optimize surgical conditions and facilitate mechanical ventilation in patients with ventilator asynchrony, on the other hand, these agents have been associated with respiratory complications and increased risk of readmission after ambulatory surgery. a consensus in regard to guidelines and thresholds to define the optimal strategy to optimize surgical conditions is yet to be achieved. we have shown that utilization of non-depolarizing muscle relaxants and their reversal agents can be improved by dedicated quality improvement techniques. we have also recently developed the reps, a tool that predicts postoperative rnmb. this is a retrospective, observational, cohort study based on on-file hospital data from beth israel deaconess medical center, boston, massachusetts. the primary aim is to validate the dichotomized reps (high-risk versus low-risk for rnmb which corresponds to a reps \>4 and \<4, respectively) for the outcome of postoperative respiratory complications with bidmc data. the investigators will utilize the pre-defined variables identified to predict residual neuromuscular blockade (reps) at bidmc. the secondary aim is to compare the predictive values of the dichotomized reps with dichotomized train-of-four (tof)-ratio (low tof-ratio versus high tof ratio which corresponds to a tof-ratio \ =0.9, respectively) for respiratory complications.

Eligibility criteria:
inclusion criteria: * 18 years or older * non-cardiac surgery * general anesthesia with intermediate-acting nmbas (atracurium, cisatracurium, vecuronium, or rocuronium) * extubated in the operating room * pacu after surgery exclusion criteria: * american society of anesthesiology (asa) physical status classification of 5 or 6 * did not receive neuromuscular blocking agents * missing last covariates

Keywords: neuromuscular blockade agents neuromuscular blockade reversal perioperative care quality improvement respiratory complication
physicians' health study

Conditions: Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Ischemia

Summary: to assess the effect on cardiovascular mortality of alternate-day consumption of 325 milligrams of aspirin and, secondarily, the effect on cancer incidence of alternate-day consumption of 50 milligrams of beta-carotene.

background: thrombosis plays a major role in the late stages of coronary occlusion. platelet aggregation is a large component in the formation of arterial thrombi. in pharmacologic studies, aspirin has been shown to inhibit platelet aggregation and, therefore, might be expected to prevent coronary occlusion. these effects are apparent in the dose range of l00-l000 mg/day, and may be most evident at l60 milligrams daily. higher doses seem to be no more effective in either inhibition of platelet agreeability or prolonged bleeding time. although an early case-control study by jick and miettinen showed a large benefit, most observational studies had shown a cardiovascular benefit of about 20 percent. conclusive data could only result from a randomized trial with a large sample size. design narrative: randomized, double-blind, fixed sample. participants were randomized into one of four treatment groups: one 325 milligram aspirin tablet every other day, alternating with one 30 milligram capsule of beta-carotene; one aspirin every other day, alternating with one capsule of beta-carotene placebo; one aspirin placebo tablet every other day, alternating with one capsule of beta-carotene; and one aspirin placebo tablet every other day, alternating with one capsule of beta-carotene placebo. major endpoints for the cardiovascular component of the study were cardiovascular mortality, total mortality, and coronary events.

Eligibility criteria:
male physicians, ages 40 to 84. no history of stroke, myocardial infarction, cancer, or renal disease. no contraindications to aspirin or beta-carotene. no current usage of aspirin or vitamin a tables greater than once per week.
observatory of the quality of surgical procedures for digestive cancers

Conditions: Digestive System Neoplasms; Surgery; Surgery--Complications; Quality of Health Care; Medical Audit

Summary: surgery for digestive cancers is managed according to quality standards, validated by the scientific community. despite the diffusion of these standards through the benchmarks of good practice, the results of the surgery remain disparate. in many countries, this "inequality of opportunity" has justified the establishment of quality assurance systems to measure the results of surgery for one or more localizations of digestive cancer. these surgical audit experiments have shown a positive, rapid and cost-effective impact on complication rates, recurrence rates and overall survival even in the absence of interventional measures. the data collected also helped to improve the management of subgroups of patients usually excluded from clinical trials. in morocco, the national cancer prevention and control plan provides for the establishment of a quality assurance system with the introduction of a system for monitoring and evaluating the care of patients. this pilot project is part of this framework, for the group of patients who are candidates for surgery for digestive cancers.


Eligibility criteria:
inclusion criteria: * patients operated for a digestive cancer, proven or suspected, in a curative or palliative intent in elective situation: inclusion from surgery programming in emergent situation: inclusion no later than 72 hours after surgery * cancer proven or suspected in the following digestive tract: colon, appendix, anus, rectum, esophagus, stomach, eso-gastric junction, bile ducts, ampulla of vater , pancreas, duodenum, small intestine and liver. * patient willing and able to agree to participate in the study exclusion criteria: * patient whose surgical intervention is indicated for: * a condition that is not a digestive tract cancer, including whether retrospectively surgical exploration and / or histological examination reveals digestive localization cancer * proven or suspected cancer of non-digestive location * a proven or suspected cancer of peritoneal localization * patient whose surgical intervention is indicated for a progressive disease or a local recurrence proven or suspected of a digestive localization cancer having already been the resected (with the exception of situations of iterative liver resection for liver metastasis hepatic and recovery of the tumor bed after the discovery of vesicular cancer on cholecystectomy specimen) * patients whose intervention is for diagnostic purposes without any curative or palliative intention * patients whose surgery is a liver transplant * patients whose surgical intervention is local destruction (radiofrequency, microwaves) exclusively by percutaneous approach (without laparotomy or laparoscopy)

Keywords: audit cancer guidelines ouctomes survival digestive cancer surgery
phase ii long term, randomized study of recombinant human insulin-like growth factor i in children with hyperinsulinism

Conditions: Hyperinsulinism

Summary: objectives: evaluate the safety and efficacy of long term recombinant human insulin-like growth factor i in children with hyperinsulinism.

protocol outline: this is a randomized, double blind, placebo controlled, cross-over study. patients are randomized to receive recombinant human insulin-like growth factor i (igf-i) or placebo subcutaneously twice daily for 4 weeks. after a 2 week washout period, patients are crossed over to the other regimen for an additional 4 weeks. completion date provided represents the completion date of the grant per oopd records

Eligibility criteria:
protocol entry criteria: --disease characteristics-- diagnosis of hyperinsulinism (i.e., evidence of fasting hypoglycemia with inadequate suppression of insulin, normal pituitary and adrenal function, and increased insulin action) suboptimal control of blood sugar (i.e., inability to fast at least 10 hours with a blood sugar of 60 mg/dl or greater) --prior/concurrent therapy-- see disease characteristics --patient characteristics-- performance status: not specified hematopoietic: not specified hepatic: not specified renal: not specified other: no other major medical conditions no known adverse reaction to recombinant human insulin-like growth factor i

Keywords: endocrine disorders hyperinsulinism rare disease
title: comparative effectiveness of asthma interventions within an ahrq pbrn

Conditions: Asthma

Summary: the overall goal is to identify best practices for improving health outcomes for patients with asthma using comparative effectiveness research within an agency for healthcare research and quality (ahrq) practice-based research network (pbrn). this goal will be achieved by completing the following aims: (1) create a centralized database for comparative effectiveness research on asthma by combining clinical and billing data from one of the largest healthcare systems in the country (carolinas healthcare system) with data from the school system, medicaid, and patient and community-level datasets; (2) deploy a fully developed integrated approach to asthma management based on the chronic care model; (3) develop and implement a "shared decision making" approach for asthmatic patients from disadvantaged backgrounds; (4) implement an electronic data collection system for an existing cdc funded school-based asthma intervention that will allow program evaluation and link school nurses with providers; (5) evaluate and compare the effectiveness of these three asthma management strategies on: overall healthcare consumption and medical costs; quality of life, school absenteeism and performance; asthma clinical measures; and medication utilization; and (6) disseminate findings across the state via the statewide pbrn and other network partners. this project has the potential to impact over 30,000 asthma patients across the carolinas including many patients from disadvantaged backgrounds.


Eligibility criteria:
inclusion criteria: all with asthma diagnosis exclusion criteria: none
a study of insulin efsitora alfa (ly3209590) compared with insulin degludec in participants with type 2 diabetes currently treated with basal insulin

Conditions: Type 2 Diabetes

Summary: the reason for this study is to see if the study drug insulin efsitora alfa (ly3209590) is safe and effective in participants with type 2 diabetes that have already been treated with basal insulin. the study consists of a 3-week screening/lead-in period, a 78-week treatment period and a 5-week safety follow-up period. the study will last up to 86 weeks.


Eligibility criteria:
inclusion criteria: * have been diagnosed with type 2 diabetes according to the world health organization (who) criteria treated with basal insulin * are receiving ≥10 units of basal insulin per day and ≤110 units per day at screening * have hba1c value of 6.5% - 10% inclusive, at screening * have a body mass index (bmi) less than or equal to 45 kilogram/square meter (kg/m²) * have been treated with one of the following stable insulin regimens at least 90 days prior to screening: * once daily u100 or u200 of insulin degludec * once daily u100 or u300 of insulin glargine * once or twice daily u100 of insulin detemir, or * once or twice daily human insulin nph * acceptable non insulin glucose lowering therapies may include 0 to up to 3 of the following: * dipeptidyl peptidase (dpp-4) iv inhibitors * sglt2 inhibitors * metformin * alphaglucosidase inhibitors or, * glucagon-like peptide-1 (glp-1) receptor agonists * participants must be willing to stay on stable dose throughout the study exclusion criteria: * have type 1 diabetes mellitus * have acute or chronic hepatitis, cirrhosis, or obvious clinical signs or symptoms of any other liver disease, except nonalcoholic fatty liver disease (nafld) * estimated glomerular filtration rate (egfr) \<20 milliliters/minute/1.73 square meter (m²) * have active or untreated malignancy * are pregnant * have a significant weight gain or loss the past 3 months * have received anytime in the past 6 months, any of the following insulin therapies: * prandial insulin * insulin mixtures * inhaled insulin * u-500 insulin, or * continuous subcutaneous insulin infusion therapy * have had any of new york heart association class iv heart failure or any of the following cv conditions in the past 3 months: * acute myocardial infarctions * cerebrovascular accident (stroke), or * coronary bypass surgery * gastrointestinal: have undergone gastric bypass (bariatric) surgery, restrictive bariatric surgery (lap-band) or sleeve gastrectomy within 1 year prior to screening
surgical treatment of hilar cholangiocarcinoma: minor or major liver resection?

Conditions: Cholangiocarcinoma; Surgical Treatment; Hepatectomy

Summary: the investigators conducted a prospective study to determine the safety and efficacy of minor and major hepatectomy selected by predetermined criteria in 138 patients with hilar cholangiocarcinoma. in selected patients, minor liver resection was a good treatment.

objective: to determine the safety and efficacy of minor and major hepatectomy selected by predetermined criteria in patients with hilar cholangiocarcinoma (hc). summary background data: for hc treated with hepatectomy, the extent of liver resection remains controversial despite extensive studies. methods: from january 2000 to december 2007, we prospectively studied patients who received surgical treatment for hc. of the 187 patients who were surgically treated, 138 (73.8%) underwent resection with a curative intent. minor hepatectomy was carried out in 93 patients who had bismuth-corlette types i, ii and iii hc without hepatic artery/portal vein invasion; and major hepatectomy in 45 patients who had type iii hc with hepatic artery/portal vein invasion, or type iv hc.

Eligibility criteria:
inclusion criteria: * criteria for resectability were absence of peritoneal or liver metastases, tumor extension to beyond secondary biliary branches bilaterally, tumor extension to secondary portal venous branches bilaterally exclusion criteria: * not in accordance with the above criteria

Keywords: minor liver resection major liver resection hilar
anemia of prematurity and hemodynamics

Conditions: Premature

Summary: the aim of this work to study the hemodynamic changes accompanying anemia of prematurity in neonates with gestational age ≤32 weeks and the effect of its treatment on hemodynamics.

this prospective observational study aims to evaluate the hemodynamic changes provoked by anemia of prematurity and transfusion of packed red blood cells (rbcs). nonanemic inpatient premature infants (hematocrit\>30%) will be compared with pretransfusional anemic inpatient premature infants. anemic premature infants will be assessed before and 24 hours after the transfusion of prbcs. cerebral, intestinal and renal blood flow velocities, cardiac output parameters will be measured in premature neonates who will fulfill the eligibility criteria of the study.this study will be conducted at the neonatal intensive care units in alexandria university hospitals.

Eligibility criteria:
inclusion criteria: * preterm infants ≤32 weeks gestational age, regardless their weight with postnatal age 3-6 weeks. exclusion criteria: -
identification of microcirculation and inflammation after posterior stabilization of the spine

Conditions: Vertebral Fracture

Summary: in this project, with unstable vertebral fractures, the microcirculation of the skin and muscle (o2c,laser-doppler/white-light -spectroscopy and contrast-enhanced sonography) will be evaluated in both conventional and in percutaneous minimally invasive technique (xia versus mantis) at the thoracolumbar junction.

in this project, with unstable vertebral fractures, the microcirculation of the skin and muscle (o2c,laser-doppler/whitelight-spectroscopy and contrast-enhanced sonography) will be evaluated in both conventional and in percutaneous minimal-invasive technique (xia versus mantis) at the thoracolumbar junction. and after placing a fixator, the inflammatory potency (laboratory chemicals, cytokines, immune status) and the muscular injury (emg) of acess are examined. the study is planned as a randomized prospective study. in the study a total of at least 100 patients should be included, 50 with minimally invasive fixation-implantation and 50 patients with conventional procedure. the radiological imaging (post-surgical control, possibly after mobilization, ct) ist routinely. the patient outcome is determined using established scores (clinical score, visual analogue scale, sf-12). the study also indicates by comparing the damage of the microcirculation of the two surgical techniques to make statements on wound healing and muscle blood flow heavily in order to filter out the less complications and tissue-method. in this research project, the limits in the microcirculation measurement with the o2c and contrast enhanced sonography be established at an early stage to help in future wound healing disorders can be treated so well.

Eligibility criteria:
inclusion criteria: older than 18 years, fracture in thoracal-lumbal region, deceleration of agreement signed exclusion criteria: under age, pregnant, pathologic fractures, history of surgery in the examined area, history of metabolic bone disease, soft tissue damage, immunodeficient, polytrauma, history of significant heart or pulmonal diseases or diabetes mellitus

Keywords: microcirculation vertebral fracture inflammation minimal-invasive surgery
risk factors of postoperative acute lung injury following liver transplantation

Conditions: Acute Lung Injury

Summary: postoperative acute lung injury (ali) during the first 72 hours after liver transplantation is not uncommon. injury may occur because liver transplantation is often associated with prolonged operative time, large volumes of fluid administration and transfusion, as well as inflammatory responses related to ischemia-reperfusion injury. for more precise perioperative fluid and hemodynamic management, modern monitoring systems, such as the pulse contour cardiac output (picco) system, have been devised and reported in recent years. the picco system uses the thermodilution technique to determine the cardiac index (ci) and thoracic fluid indices such as the intrathoracic blood volume index (itbvi), extravascular lung water index (evlwi), and pulmonary vascular permeability index (pvpi), all of which may reflect pulmonary fluid and injury status. however, perioperative changes in thoracic fluid indices in liver transplantation and their associations with postoperative ali are not yet clear. in this study, the investigators aimed to determine patterns of change in perioperative thoracic fluid indices and compare these changes in recipients who did or did not develop postoperative ali. furthermore, the investigators will also try to determine the potential risk factors following liver transplantation.


Eligibility criteria:
inclusion criteria: * end stage liver disease receiving liver transplantation in ntuh. * age: 6 months old to 75 years old exclusion criteria: * history of pulmonary resection, * chronic respiratory insufficiency * cardiac dysfunction * failure of the surgery.

Keywords: extravascular lung water pulmonary vascualr permeability index liver transplantation
evaluating telehealth delivery of brief alcohol screening and intervention for college students

Conditions: Alcohol Consumption

Summary: this research study will test the efficacy of a telehealth version of the brief alcohol screening and intervention for college students (basics), which is the gold standard prevention and intervention approach to target heavy alcohol use on college campuses across the united states.

in this study, the researchers will evaluate the efficacy of a tele-basics approach utilizing the zoom application compared to in-person basics and a lower threshold treatment as usual intervention. three hundred mandated and 300 volunteer students who report hazardous drinking will be recruited from two large universities and randomly assigned to a condition (in-person basics, tele-basics, or treatment as usual). follow-up assessments will occur 1-, 3-, 6-, and 12-months post-baseline. the significance of this research lies in the potential to maximize access to the highest standard of care by establishing support for easier access without sacrificing any central features of the traditional basics intervention. in addition, many universities pragmatically adapted existing in-person interventions to remote-telehealth approaches in response to the covid pandemic but now have no scientific basis for determining whether transitioning back to in-person approaches would be beneficial.

Eligibility criteria:
inclusion criteria: * between 18 and 26 years of age * fluent in understanding english * a registered student at one of the two intervention sites * adequate internet capabilities to support video-conferencing * access to a webcam, which is a standard features of most laptops, mobile devices, and desktops * engage in binge drinking (i.e., 4 or more standard drinks in a sitting for women or 5 or more standard drinks in a sitting for men) at least once in the past month (for the volunteer sample only) * experienced at least one negative alcohol-related consequence in the previous month (mandated students would meet this due to receiving an alcohol sanction) * reports a score of 2 or higher on questions about a) interest in reducing their drinking, or b) interest in not increasing their drinking. exclusion criteria: * not meeting inclusion criteria or unwillingness to participate

Keywords: alcohol drinking brief intervention teleheath